Clinical Endoscopy | 2021
Colon Capsule Endoscopy: An Alternative for Conventional Colonoscopy?
Abstract
To increase the screening numbers among patients unable or reluctant to undergo conventional colonoscopy alternative screening modalities might be offered. Colon capsule endoscopy (CCE) is a widely used non-invasive imaging, radiation-free method for directly visualizing colon and rectum. CCE was initially met with skepticism, because of the need for extensive bowel cleansing protocols, long evaluation time, impossibility to take biopsies and remove polyps and high procedural costs. Concerning polyp and cancer detection, several prospective studies have compared CCE with conventional colonoscopy. In these studies, sensitivity and specificity for identifying colonic lesions with CCE was relatively low in comparison with colonoscopy. In this issue of Clinical Endoscopy, Hausmann et al. attempted to provide real-world data on CCE in a large prospective German cohort. In this registry trial, CCE (CCE-2) was performed in patients unable or unwilling to undergo colonoscopy that was indicated for various reasons. A total of 161 patients underwent CCE at six German centers between 2010 and 2015 and their data were analyzed. The most frequent clinical indications for CCE among 153 analyzed patients were clinical symptoms (n=72, 47%) and colorectal cancer (CRC) screening (n=55, 36%). For those patients, the most frequent reasons for undergoing CCE were the patients’ specific request to undergo CCE instead of colonoscopy (n =85, 56%), and having undergone an incomplete colonoscopy (n=51, 32%). Visualization of the entire colon was obtained by CCE in 69% (n=111) of patients. In 52 of 161 CCE investigations (32%), at least one polyp was detected; 24 (15%) had a non-diminutive polyp (>6 mm). In two patients (1.2%) the suspicion of an adenocarcinoma was raised, which was histopathologically confirmed after surgery. In one patient, known with inflammatory bowel disease, the capsule was stuck in a benign stenosis of the small intestine and had to be removed surgically. This study provides us with some insights in the use of CCE in daily practice. We would like to discuss several aspects of CCE. First of all, the success rate of the procedure (i.e., entire visualization of the colon), which still is relatively low at 69%. The reasons for unsuccessful CCE were incomplete small bowel and/or colon passage (n=33), inadequate bowel cleansing (n=7) and technical malfunction (n=2). In those patients having undergone a previous incomplete colonoscopy, it could be interesting to know if the colonic segments that were not reached during the previous colonoscopy were now visualized with CCE, resulting in a full colon examination when adding up the two. If so, CCE might indeed be a valuable option after incomplete colonoscopy, but if this is not the case, computed tomographic colonography (CTC) seems a better alternative. The European Society of Gastrointestinal Endoscopy (ESGE)/ COMMENTARY